Faculty Bibliography

PURPOSE/OBJECTIVE:This prospective, non-randomized phase II single-arm pilot trial aimed to explore favorable mid-treatment nodal response (FMNR) through CT imaging to guide de-escalated chemoradiation therapy (CRT) in patients with favorable risk, node-positive HPV-associated oropharyngeal cancer (OPC). MATERIALS AND METHODS/METHODS:. At week 4, CT imaging evaluated nodal response: ≥40% reduction warranted de-escalation to 60 Gy, while <40% reduction continued standard CRT. Primary endpoint was 2-year PFS from initiation of dose de-escalated CRT. Tissue tumor modified viral (TTMV) HPV DNA samples and DW-MRI were collected at baseline and week 4. MDADI questionnaires were collected at baseline, 1, 3, 6, 12, and 24 months. RESULTS:Of 39 patients, 26 had FMNR and underwent de-escalated treatment. 13 pts had slow mid-treatment nodal shrinkage and received standard dose. At a median follow-up of 47.4 months, the 2-year PFS was 92.1% (95% CI: 0.72-0.98) for the deescalated dose group and 92.3% for the standard dose patients (95% CI: 0.57-0.99), p=0.96. With a median survival follow up of 48.9 months (range: 16.7-77.8 months), there were no deaths or distant failures. FMNR was associated with rapid TTMV HPV DNA clearance, reduced TTMV HPV DNA flare, lower baseline and week 4 MRI diffusivity, and higher baseline and week 4 MRI diffusional kurtosis. No differences in acute or late maximum grade 3-4 toxicity by patient were noted. MDADI composite scores showed minimal clinical important difference (MCID) in the de-escalated group at 1-month post-treatment while the standard group had MCID up to 1-year post-treatment. No patients required feeding tube placement. CONCLUSIONS:De-escalated CRT using CT-based mid-treatment nodal response in favorable risk, node-positive HPV-associated OPC achieved excellent 2-year PFS and OS rates and represents a potential approach in better selecting patients for treatment de-escalation.

OBJECTIVE:To assess the environmental impact of radiography and fluoroscopy, using life cycle assessment (LCA), focusing on energy use and emissions. METHODS:This ISO 14040-guided LCA-based study focused on radiography and fluoroscopy services, including the production and use of two radiography and two fluoroscopy machines, at a quaternary care 800-bed academic medical center in the Southeastern United States over a 1-year period. Data were collected through direct observation, record review, staff interviews, and energy metering. Environmental impacts were assessed using SimaPro 9.3.0.2 and the Ecoinvent v3.8 database. RESULTS:e per scan). Medical linens or textiles accounted for 24% of total emissions. Other significant environmental impacts included ozone depletion, smog, acidification, and eutrophication. DISCUSSION/CONCLUSIONS:Reducing energy consumption by decarbonizing electricity sources and optimizing equipment use can significantly decrease greenhouse gas emissions. Implementing sustainable practices in linen use, procurement, and end-of-life management is also crucial. Reducing low-value imaging can further mitigate environmental impact.

OBJECTIVE:Lupus nephritis (LN) management remains challenging, and novel noninvasive biomarkers are needed. This study quantified serum soluble mediators in the Accelerating Medicines Partnership (AMP) LN cohort to identify biomarkers of histological features and treatment response. METHODS:SLE patients (n=268) undergoing clinically indicated kidney biopsies (urine protein/creatinine ratio [UPCR] > 0.5) were recruited through the AMP RA/SLE network. Serum was collected at biopsy and 3-, 6-, and 12-months post-biopsy, alongside samples from 22 healthy controls. Concentrations of 66 immune mediators were quantified using xMAP multiplex assays, and TNF-α converting enzyme (TACE) measured by ELISA. Seven mediators with >95% values below detection limits were excluded from analyses. Bootstrapped LASSO regression identified proliferative LN (class III/IV+V) predictors from baseline mediators. Associations with 12-month treatment response (complete/partial vs. no response) were tested using 3-month changes in LASSO-selected mediators and UPCR via logistic regression. Molecular clustering of mediator profiles was performed to identify LN subgroups. RESULTS:Proliferative LN patients (class [III or IV] + V; n=160) displayed a distinct mediator profile compared to non-proliferative LN (class I/II/V; n=96). LASSO regression identified 20 mediators predictive of proliferative LN (AUC, 0.82; 95% CI, 0.81-0.91), including elevated syndecan-1, TNFRI, TNFRII, and VCAM-1, as well as decreased CCL3/MIP-1α, CD40L, and IL-5 levels. Among proliferative LN patients, 3-month reductions in syndecan-1 and VCAM-1, mediators associated with intrarenal LN activity and/or chronicity, predicted 12-month treatment response. A model incorporating these reductions and a decline in UPCR predicted treatment response in proliferative LN (0.90; 95% CI, 0.82-0.98). Molecular clustering revealed 4 distinct LN subgroups with unique soluble mediator signatures and clinical features, not captured by histology alone. CONCLUSION/CONCLUSIONS:Serum soluble mediators, particularly syndecan-1 and VCAM-1, reflect LN histological activity and early decreases predict treatment response, supporting their potential utility as noninvasive longitudinal biomarkers. The substantial heterogeneity within LN highlights the potential for biomarker-guided reclassification to advance precision medicine approaches.

Osseointegration is critical for the long-term success of endosteal implants, as it is influenced by factors such as implant design, material selection, and site of implantation. Considering the structural and vascular properties of trabecular bone, it is reasonable to hypothesize that osseointegration could be enhanced in this region. However, emerging evidence indicates that cortical bone frequently offers a more favorable environment for osseointegration. The objective was to conduct a systematic review of preclinical translational studies comparing osseointegration outcomes around implants placed in cortical and trabecular bone. Preclinical studies comparing bone-to-implant contact (BIC) and bone area fraction occupied (BAFO) between cortical and trabecular regions in animals with solid endosteal implants were retrieved from the PubMed, EMBASE, and Cochrane databases. We included randomized and nonrandomized preclinical translational trials published in English between 2014 and 2024 that reported at least one outcome of interest. Exclusion criteria comprised in vitro or ex vivo experiments, research involving human subjects, studies using powder, liquid, or plasma implants, abstracts, technical descriptions, and narrative or systematic reviews. The systematic review comprised 15 studies, which included a total of 298 animals and 877 implants. The mean follow-up period ranged between 4 and 17 weeks. In 13 studies, the cortical bone region demonstrated higher BIC values, with differences in BIC between cortical and trabecular bone ranging from 5.55% to 49.55% during the first 4 weeks, 1.80% to 51.30% between 4 and 8 weeks, and 9.65% to 35.41% following the 8-week healing period. Regarding BAFO values, data were reported in three studies, all of which indicated elevated values in cortical bone. The mean difference in the first 4 weeks ranged from 15.83% to 29.92%, and from 26.33% to 60.11% after 4 weeks of healing. These findings suggest that cortical regions exhibit enhanced short- and long-term osseointegration outcomes compared to trabecular bone regions. Impact Statement The specific site of implantation significantly influences the degree and rate of osseointegration. Trabecular bone, characterized by its high porosity and larger surface area relative to volume, facilitates the diffusion of nutrients and oxygen from the surrounding marrow and blood vessels. Nevertheless, emerging evidence indicates that cortical bone, due to its greater density and superior mechanical properties, often provides a more stable environment for osseointegration compared to trabecular bone. This systematic review of preclinical studies represents the first comprehensive effort to evaluate and compare osseointegration in cortical versus trabecular bone.

PURPOSE/OBJECTIVE:To estimate economic and environmental reduction potential of iodinated contrast media (ICM) saving strategies, by examining supply chain data (from iodine extraction through administration) to inform a decision-making framework which can be tailored to local institutional priorities. METHODS:A 100 mL polymer vial of ICM was set as the standard reference case (SRC) for baseline comparison. To evaluate cost and emissions impacts, four ICM reduction strategies were modeled relative to this SRC baseline: vial optimization, hardware or software (AI-enabled) dose reduction, and multi-dose vial/injector systems. This analysis was then translated into a decision-making framework for radiologists to compare ICM strategies by cost, emissions, and operational feasibility. RESULTS:The supply chain life cycle of a 100 mL iodinated contrast vial produces 1,029 g CO2e, primarily from iodine extraction and clinical use. ICM-saving strategies varied widely in emissions reduction, ranging from 12%-50% nationally. Economically a 125% tariff could inflate national ICM-related costs to $11.9B, the ICM reduction strategy of AI-enhanced ICM systems could lower this expenditure to $2.7B. Institutional analysis reveals that the ICM savings from high-capital upfront investment strategies can offset their initial investment, highlighting important trade-offs for implementation decision-making. CONCLUSION/CONCLUSIONS:ICM is a major and modifiable contributor to healthcare carbon emissions. Depending on the utilized ICM-reduction strategy, emissions can be reduced by up to 53% and ICM-related costs by up to 50%. To guide implementation, we developed a decision-making framework that categorizes strategies based on environmental benefit, cost, and operational feasibility, enabling radiology leaders to align sustainability goals with institutional priorities.

BACKGROUND:Emerging blood tests may improve colorectal cancer (CRC) screening uptake and outcomes but are less sensitive for advanced precancerous lesions than some currently recommended tests. We examine whether these tests meet expectations for U.S. Preventive Services Task Force (USPSTF) recommendation. METHODS:A decision-analytic model that informed USPSTF was replicated and used to estimate the lifetime benefits (averted CRC cases & deaths, life-years gained [LYG]), burdens (required screening tests & colonoscopies), and harms (colonoscopy-related complications) for annual, biennial or triennial blood testing through age 45-75 years vs a benchmark of recommended and contemporary stool-based strategies, with colonoscopy screening as the reference. Base-case analyses assumed 100% adherence. Sensitivity analyses evaluated more realistic scenarios. RESULTS:Among benchmark strategies, colonoscopy screening had the most benefit, with an estimated 30 CRC deaths averted, 356 LYG, 4270 colonoscopies required and 15 complications per 1000 adults; stool-based strategies resulted in 81-88% of LYG for colonoscopy, 6829-19,476 screening tests, 1523-1880 colonoscopies, and 9-10 complications. By comparison, annual blood testing resulted in 85-87% of LYG for colonoscopy and an intermediate number of screenings, colonoscopies and complications. Biennial and triennial blood testing provided 57-72% of LYG for colonoscopy but resulted in net population benefit under plausible scenarios for increased utilization vs existing strategies. CONCLUSIONS:The estimated benefits, burdens and harms of annual blood testing are within the range of current CRC screening strategies. Biennial and triennial testing should also be considered for recommendation given potential for increased utilization and net population benefit.